George C F, Boudreau A C, Smiley A
Department of Medicine, University of Western Ontario, London, Canada.
Am J Respir Crit Care Med. 1996 Jul;154(1):175-81. doi: 10.1164/ajrccm.154.1.8680676.
To assist in determining ability to drive in patients with obstructive sleep apnea (OSA), we developed a divided attention driving test (DADT) based on the work of Moskowitz and Burns (6). We first examined its ability to detect impaired performance by testing normal subjects both sober and impaired by alcohol (mean blood alcohol level, 95 +/- 25 mg/dl). Subsequently, 21 male patients with OSA (age 49.3 +/- 12.7 [SD] yr; apnea hypopnea index [AHI] 73 +/- 29) and 21 age- and sex-matched control subjects underwent polysomnography followed by daytime sleep latency testing (MSLT). Before each day-time nap, subjects were given the DADT for 20 min. Patients who performed much worse than control subjects in all measures, with the largest difference noted in tracking error (OSA, 228 +/- 145 cm versus control 71 +/- 31 cm, p < 1 x 10(-9)). Half of the patients were worse than any control subject, with some showing performance worse than control subjects impaired by alcohol. However, MSLT and AHI explained less than 25% of the variance in tracking error, making individual prediction problematic. We concluded that in laboratory driving performance skills are markedly impaired in over half our group with sleep apnea. Further testing and comparing on-road performance should aid in predicting ability to drive.
为了协助确定阻塞性睡眠呼吸暂停（OSA）患者的驾驶能力，我们基于Moskowitz和Burns的研究成果（6）开发了一种分心驾驶测试（DADT）。我们首先通过测试清醒和酒精影响状态下（平均血液酒精浓度为95±25mg/dl）的正常受试者，来检验该测试检测性能受损的能力。随后，21名男性OSA患者（年龄49.3±12.7[标准差]岁；呼吸暂停低通气指数[AHI]为73±29）和21名年龄及性别匹配的对照受试者接受了多导睡眠监测，随后进行白天睡眠潜伏期测试（MSLT）。在每次白天小睡之前，让受试者进行20分钟的DADT测试。在所有测量指标中，患者的表现均比对照受试者差得多，跟踪误差方面差异最大（OSA患者为228±145cm，对照受试者为71±31cm，p<1×10⁻⁹）。一半的患者比任何对照受试者表现都差，有些患者的表现比受酒精影响的对照受试者还要差。然而，MSLT和AHI对跟踪误差方差的解释不到25%，这使得个体预测存在问题。我们得出结论，在实验室环境中，超过半数的睡眠呼吸暂停患者的驾驶性能技能明显受损。进一步测试并比较实际道路上的表现应有助于预测驾驶能力。
